Kelly Gotberg, PT, DPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

5501018868 Issued in MI

Practice address

854 Washington Ave Ste 200
Holland, MI 49423-7143

Phone

(616) 392-9430

NPI assigned

Sep 19, 2018

Last updated

Sep 19, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelly Nemeth Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1265916852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5380 LAKE MICHIGAN DR",
            "city": "ALLENDALE",
            "state": "MI",
            "postal_code": "494019484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "854 WASHINGTON AVE STE 200",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494237143",
            "telephone_number": "616-392-9430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTBERG",
        "first_name": "KELLY",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-19",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MI",
            "license": "5501018868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "NEMETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Orthopedic Physical Therapist in Holland, MI
• Providers in Holland, MI by specialty
• Orthopedic Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.